New CARC Codes Coming to TexMedConnect for Texas Medicaid Providers on June 6
Starting June 6, 2025, Texas Medicaid & Healthcare Partnership (TMHP) will add new Claim Adjustment Reason Codes (CARCs) to TexMedConnect. These new codes follow HIPAA rules and apply to Texas Medicaid.
Providers will find these new CARCs in the Adjustment Reason Code drop-down menu under the “Disposition” section in TexMedConnect.
This update enables TMHP to handle claims that include other insurance details in TexMedConnect. The way these claims are processed depends on the number of other insurance instances included in the Electronic Data Interchange (EDI) 837 claim transaction.
New CARC Codes
The Texas Medicaid & Healthcare Partnership (TMHP) will add the following Claim Adjustment Reason Codes (CARCs):
- 303: The previous payer's patient responsibility is not covered for those eligible for both Medicare and Medicaid.
- 304: These services are not covered under this plan. Please submit them to the patient's hearing plan for review.
- 305: These services are not covered under this plan, but the claim has been sent to the patient's hearing plan for further review.
- 306: The type of bill does not match the patient's status.
- P32: Payment has been adjusted due to apportionment.
Note
TMHP will deny claims submitted to Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program if they include other insurance information. This applies when the Claim Adjustment Reason Code (CARC) shows that the provider incorrectly billed the other insurance. Providers must find and fix any billing errors in claims sent to primary payers before submitting them to Texas Medicaid for payment review.
EDI Companion Guides Update
TMHP will revise the following EDI Companion Guides to reflect these changes:
- 837D Acute Care Companion Guide
- 837I Acute Care Companion Guide
- 837P Acute Care Companion Guide
For more details, contact the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
